Feeding your baby who has a recessed jaw
Updated: Nov 10
Babies with a recessed jaw may have unique feeding challenges which cause a squeaking sound when they breath (stridor) and cause them to have to work harder to eat. We can help our babies with a few adjustments to their feeding.
Stroking the tongue forward from the middle of the tongue to the tip just before feeding can help move the tongue to a better position for latching.
Using a nipple shield with feeding may help baby place their tongue in a better position for effective feeding. Watch a video here to see how to properly put on a shield Latch
Latching with baby position with their head tipped back, chin touching the breast first and the nipple at nose level allows baby to attach to the breast better.
A Koala or Laid-Back position can help with this. You can also Side-Lie with your baby on a safe surface.
1. Start with baby on your lap , facing you, with their knees bent and straddling your thigh.
2. Bring baby close to your body and wrap your "nursing-side" arm around them for support. You can bring your leg in closer or move your foot away to position baby so they are tilting their head back slightly and your nipple is at the same height as baby's nose.
3. Lean back and relax your shoulders back to "open" your chest toward your baby. Using a pillow behind you can help support your low back.
4. Using the hand not supporting baby, support your breast and guide baby into latch.
5. Baby will root around and latch on, you can help support, but resist the urge to put your breast into baby's mouth as this can result in a shallow attachment.
Video showing how to do this: https://tinyurl.com/3pm7k2xt
You can support under baby's chin with a finger during nursing or bottle feeding which can allow baby to have better function during feeding.
Image: Mattos Lactation
Baby may have to suck harder to get enough milk due to their shorter tongue and jaw. This can result in nipple pain. Drying the nipple and using warmth after feeding can reduce pain.
Generally, laying baby on their side with their head slightly elevated and baby's hips turned slightly up works best. Baby will likely need lots of breaks for pacing bottle feeding.
Paced Bottle Feeding Steps:
1. Choose a small, 4 oz. bottle and a slow flow nipple.
2. Hold baby in your lap in a semi-elevated position, laying on baby's left side (see picture below).
3. When baby shows hunger cues, touch the nipple to baby's lip so they opens their mouth wide.
4. Insert nipple into baby's mouth, making sure baby has a deep latch with the lips turned outward.
5. Hold the bottle flat (horizontal to the floor).
6. Let the baby begin sucking on the nipple with the bottle angled just enough to fill the nipple about halfway with milk.
7. Watch baby during the feeding: cues that baby may need a break can include leaking milk, hands held with the fingers wide apart, a creased brow, wide open eyes that look startled, gulping, or clicking noises
8. Every 1-2 minutes or if you notice any stress cues, tip the bottle down and remove it from baby's mouth keeping the nipple just touching baby's lips.
9. After a few seconds baby will try to latch back onto the nipple.
Signs of too fast flow: agitation and grimacing gasping for air taking frequent breaks panicked look in the eyes milk leaking from the corners of the mouth coughing or sputtering flailing arms pushing the bottle away Signs of too slow flow: agitation shaking the head back and forth refusing a bottle biting on the nipple Tongue tie
Tongue tie (in which the attachment from the bottom of the tongue to the floor of the mouth is too tight to allow normal movement) can often occur with a recessed jaw. This doubly makes it hard for baby to feed well. An in-office procedure can release the tongue and allow for better movement. Working with your Lactation Consultant after the release procedure (frenotomy) can help strengthen and coordinate baby's suck.
Bodywork (or manual therapy *click the link to read more*) can be helpful for many feeding challenges. In the case of baby with a recessed jaw, a pediatric provider can release jaw tension and the hyoid bone which will allow for the best function and movement possible. “The tongue is elevated toward the palate by the combined actions of the digastric, genioglossus, geniohyoid, and mylohyoid muscles. Elevation of the tongue may be compromised if there is restriction in the mobility of the hyoid bone, in effect tethering the tongue.”
The majority of infants with a slightly recessed jaw outgrow these feeding concerns. At around 3-4 months of age the infant's neck elongates and as the jaw moves forward with facial growth. This brings the tongue slightly forward with increased space allowing for functional tongue elevation and retraction. At this point most infants can transition to more traditional breastfeeding positions.
If baby shows any stress responses when lying on their back, if you notice any potentially obstructive noises during sleep, or if your baby spontaneously moves themselves from their back to side lying then ask your pediatrician about a referral for a sleep study and/or airway patency assessment which can be done by an otolaryngologist (ENT).